I usually have a sense of what the person’s problem geography is at the end of a 30 minute consultation. In an initial 30 minute consultation we’re just kind of seeing if therapy is a good fit, explaining what we do and clients just tend to be pretty open about things.

When you get into a session clients can be kind of guarded and they are doing some impression management, trying to make sure that you don’t think badly of them because they have this problem that they are seeing you for. It’s kind of a funny dynamic that way. So I love the consultation because I get more juicy information in those 30 minutes than I do in the first session. It gives me a foundation to begin to probe and to look for the patterns of what they do and how they do it.

A lot of times what I find is that in the first real session they don’t really tell me a lot more than in the consultation but they clarify some of the beginning patterns. How I construct these patterns is that I’m always looking for what part of it has to do with how they see themselves, what part of it has to do with the rules that they have for themselves in relation to this situation or that situation. In certain situations they say to themselves I have to do this or they perceive themselves as that. I’m always kind of deconstructing the situations and constructing the patterns as I hear their stories.

A lot of times people don’t realize that things are related to what they’re related to. They best way to explain this is in a case example.

The Woman with a Weight Problem

I had a woman come in who was having a problem losing weight. And she talked about how depressed she was because of the weight. When I begin to look at the pattern, what I found was that in her family to be connected they had meals together where there was lots of food where you were supposed to eat vigorously to show that you cared.

Years later, as an adult, even though she was living in Arizona and her family is all back east she equated the relationship so that food really meant being connected to family and she was kind of feeling the loss of her family every time she deprived herself of food. I really didn’t need to do any therapy as I uncovered that, through discussion she said to me at the end that second session well that’s kind of silly. And I told her, no that’s just how you constructed it. So se said, “Oh, well, I don’t want to do that anymore” and she was done. End of therapy.

I got most of the initial groundwork out of the consultation and then I looked for patterns in the first session and by the second session she had really clarified what all of this meant to her, looked at it and said “I don’t have to keep doing that. That’s not helping me”. She was a successful case after that.

When someone comes into your office with a complication, what should they expect from that half an hour initial consultation?

Generally when the client makes an appointment, I’ll talk to them a little bit about what they can expect when they come in. And we’re going to kind of get a feel for each other, see if we can work together. I’m going to explain how we do therapy here. You’re going to tell me a little bit about what’s going on with you and then we’ll see if it’s something that will work for both of us.

There are a couple of basic things that I want to get accomplished in an initial consultation.

One is that they understand that we are not going to rush them into treatment. We are going to take our time and really understand what the problem is and by starting slow we’ll finish fast. It sounds out of synch but it’s really true. The better you understand what the problem is the more quickly you can move in therapy.

The other thing that I want to do is talk about good fit. These are things that we kind of expect to happen because…and I’ll explain you’re only going to be here for an hour every other week and ask do you have the energy and time to really work on things outside of session?

I’ll give them examples of two or three types of interventions that I’ve used in the past with people. The Marshmallow exercise is a really easy. People kind of laugh at stuff like that. I have others. I gave one family these foam rubber toxic signs to wear around their necks when they began to realize that they were arguing.  I go through two or three of those things and explain that these are the types of assignments you need to do outside of session to make therapy work.

And so I’ll ask do you have the time and the energy to really be working on this right now. I know you’re in pain and you want it to go away but do you really have the energy to make it better now? A lot of time I find what they do is that they start seeing it as if I’m almost trying to take it away from them, and I’m not and they’ll just kind of tell me all the reasons why they can do it right now.